Yet skin disease remains one of the top ten work-related diseases in American workplaces, accounting for nearly 40 percent of all occupational illnesses and costing American industry $1 billion a year, according to one estimate. (Skin care experts say even that number is low, because most cases of dermatitis go unreported.) And the National Safety Council reports more than 500,000 disabling injuries to hands and fingers occur to workers each year. Still, protecting hands tends to get overlooked as a safety issue. Some workers simply associate rough, beat-up hands with manual labor. And many are unaware of the worse damage that can result when cut, nicked and cracked hands are exposed to chemicals.

As technical sales manager for glove manufacturer Mapa Professional, Rita Meigs says her first challenge at a new site is often just getting workers and employers to recognize that they have skin care problems. Meigs starts by observing her new customers' personal hygiene and hand protection practices before making glove recommendations. Most companies "absolutely do not" have hand protection programs in place, she says. Workers who think having chapped or red hands is just part of the job need to be educated, says Armand Coppotelli, a former OSHA compliance officer and now a skin care specialist with Stockhausen, Inc. "What might look like just plain old dry hands could lead to bigger problems. When the stratum corneum-the skin's outermost layer-is weakened, chemicals can more easily penetrate and damage the living skin cells in the dermal layer," Coppotelli explains.

Old Habits Die Hard For tips health and safety managers can use to assess workers' hand and skin care needs, Industrial Safety & Hygiene News talked to several skin care product and glove manufacturers. To be sure, hand protection habits have improved noticeably since workplaces began complying with OSHA's Personal Protective Equipment standard, say most vendors.

Tami Heavner, manufacturer's representative for professional skin care product manufacturer GOJO, says with more workplaces mandating glove use, she has seen less need for extremely heavy-duty hand cleaning. Nelson Schlatter, Ansell Edmont's chief chemist of analytical services, who mans a telephone hotline for customers and distributors of Ansell products, has seen a drastic increase in glove interest, if not use: Schlatter says he started as "the Ansell voice on the phone" 15 years ago responding to a few calls a month. This July, he received 350 phone inquiries.

"More and more people are 'gloving up'," says Logan Boss, marketing director for glove maker Marigold Industrial. Boss says increased glove use is noticeable particularly in the automotive maintenance industry: "Traditionally people who worked on cars and trucks never wore gloves. They're realizing they're better off at the end of the day coming home with clean hands."

But old habits die hard. Where skin care needs have changed, in many cases the products a plant uses have not, says Heavner. For instance, workers who used solvents to clean off heavy grease might still be using solvents to wash hands that have been protected by gloves all day. Coppotelli sees workplaces where pumice and sand are still used for washing up. "They've done things the same way for 30 years and don't want to try some new way," he says.

The same traditionalism goes for gloves. "People are creatures of habit," says Perfect Fit sales representative Matt Bauman. "Customers will say, 'We've been using leather gloves for 20 years. Why would we want to change?'"

Marigold's Logan Boss says American customers' resistance to trading in leather for synthetic leather products makes him wonder if workers here don't have an emotional attachment to the smell of leather and their roots as frontiersmen.

Whatever the reasons are for resisting change, Coppotelli and others recommend assessing your workplace with the following checklist to get around old habits and determine if the hand care needs of your workers are being met:

Questions to ask - What is the current skin condition?

"I try to watch workers work. Then as I'm talking to them I'll observe redness, cracks, dryness, or definite signs of chemical exposure," says Rita Meigs.

Says Coppotelli, "We'll see people with splits around their cuticles or bandages around the joints of their fingers because they split and crack from chemicals or low humidity in winter. You'll see employees in metalworking handling water-based coolants that are alkaline with little metal chips that can cause micro-wounds on the skin leading to infections and more serious rashes."

Are good industrial hygiene practices being used?

For instance, instead of using an epoxy that can cause allergic skin reactions, consider a polyester resin. If workers are using a solvent soap to clean a mechanical part and then cleaning their hands with it, get rid of the solvent soap rag and start using gloves.

Best Manufacturing sends its 30 U.S. salespeople into customers' plants armed to conduct an OSHA-compliant PPE hazard assessment for hand protection. Worldwide, Best distributes a software program to assist industrial hygienists with the glove selection process. "We try to become a tool for the safety director," says Best International Sales and Marketing Manager Craig Wagner. "You've got so many variables to consider-abrasion, sunlight, heat, cuts, human error-that's where the safety person is burdened."

Are gloves being worn and changed often enough?

ASTM test methods require that chemical-resistant gloves-natural rubber, nitrile, neoprene, PVC, etc.-be tested for permeation over eight hours, says Meigs. That means beyond eight hours of chemical exposure, a glove isn't necessarily safe against permeation.

"If you get a chemical on the glove at eight in the morning, and lay it down somewhere, and pick it back up at noon, you have no idea how much damage has been done. At least throw them away every day," Meigs says. More often at smaller plants, Meigs says no policy exists for changing gloves: "They say, 'We change them when they have a hole or after a month'."

Garner advises checking the MSDS for recommendations on the appropriate gloves and the duration. And keep an eye on the gloves: "Discoloration or disfiguration of the glove will be an indicator if it's time to dispose," he says.

What are employees handling?

When recommending a product, Meigs says she looks at how quickly any chemicals an employee could come into contact with could permeate the glove. "You have to consider, maybe one chemical doesn't do anything to the glove but another permeates it. Say hydrochloric acid doesn't affect the glove, but if the glove becomes compromised in another application, then the acid will be able to cause a burn."

Meigs worked with one customer whose workers wore a disposable type glove to handle dilimonine. "These people had severe dermatitis on their hands and clear up their arms. We recommended wearing cotton glove liners that they change no less than four times a day to reduce moisture and allow the area to heal."

Some glove manufacturers can custom-design gloves to meet particular needs. For a wind turbine maker in Denmark where workers are exposed to a fiberglass product composed of styrene, Marigold Industries designed a glove that can hold up to styrene exposure for over one hour. Such customization is a trend Marigold's Logan Boss predicts might become more common. But, he says, "a lot of marketing assessments need to be made before we'd make [a product] for just one customer." Ansell Edmont's Nelson Schlatter, says he'll run tests free of charge for customers to help determine what glove is best for their contaminant. Whether they'll develop a custom product depends as well on market demands. Says Schlatter, "If you're a veterinarian working with a chemical that might help five dogs in the country, forget it." But, he says, if there's potential to help automotive workers across the nation, that's another story.

What is lurking in the bathroom?

"Pink soaps, or coconut oil based soaps aren't designed to take off any heavy contamination," says Coppotelli. "Some people complain about drying on the skin. Synthetic detergents that can be pH-balanced clean better than soaps derived from animal by-products with a lot of alkalis and fatty acids," he says.

Education is key, adds Coppotelli: "The second-leading cause of dermatitis is improper handcleaners. Harsh cleansers can aggravate a skin condition and never allow the hands to clear up."

Heavner advises ensuring that you have the right products in the right location and that you have clean, hygienic dispensers. "You would not believe the dispensers that have mold growing in them or bar soaps that people share," she says.

Are workers using protective creams?

Marketing claims about barrier creams can give a false sense of security, says Coppotelli. "A claim that a barrier cream can repel hydrochloric acid depends on the concentration of acid. You need efficacy studies.

As for claims that a cream repels blood, if I'm going to be around blood infected with the HIV virus I wouldn't rely on a protective cream," Coppotelli says.

Are the creams matched to the proper application?

• For protection against petroleum-based hazards, Coppotelli recommends creams that are water-based to naturally repel the petroleum solvent.
• For protection against water-based hazards, creams should be oil-based. ·
• For mechanical type irritants such as fiberglass, there's a protectant to prevent it from getting embedded into skin. ·
• There are creams that work against resin, epoxy and multicomponent type resins, and against allergic type chemicals that irritate the skin (water-based coolants and cutting oils, metal dust, petroleum fiberglass, etc.).

Keep in mind that creams must be applied over clean skin. And they have a duration time just like gloves.

What are workers using to clean their hands?

• Are painters using paint thinner to clean their skin? "Nine times out of ten they do," says Coppotelli. "But NIOSH studies have shown that within 15 minutes, components of paint thinner will appear in the body." ·
• Are workers using granular (borax) type cleaners? Borax cleaners remove the outermost barrier, the stratum corneum which can make skin more susceptible to rashes and dermatitis. "It's like washing with rocks," says Coppotelli. ·
• Are the handcleaners heavy, solvent type waterless cleansers? This method takes off the skin's natural protective barrier. ·
• Are they dilimonine-based? Dilimonine is a natural solvent taken from orange peels used as a substitute for petroleum solvent. But this too is treated in a way that can cause some dermal irritation, Coppotelli warns. "It's good as a floor and wall degreaser. But on the skin it's not the panacea that some people might think." Coppotelli, a former OSHA compliance officer himself, says though OSHA is vague on skin protection, he promotes a three-point skin care program: "Protect while working, use proper cleanser, then skin cream after work," he says.